Drug Policy in Latvia.

We present a general overview of the health care system as well as the pricing and reimbursement environment in Latvia. Overall, the pharmaceutical sector in Latvia, including pricing and reimbursement, is strictly regulated. The main Latvian stakeholder in the pharmaceutical sector is the Ministry of Health. The State Agency of Medicines and the National Health Service (NHS) are also important institutions for regulation of pharmaceuticals, including pricing and reimbursement. The NHS is the most important institution for regulation of reimbursement of pharmaceuticals. It is responsible for health technology assessment and also for implementing decisions regarding the reimbursement of pharmaceuticals by including medicines in the positive reimbursement lists for outpatient care and defining positive lists of medicinal products for inpatient use. The reimbursement of expenditures for medicinal products and medicinal devices for outpatient care is a main part of drug funding in Latvia. Reference pricing is in place and prices are revised 4 times a year. The positive reimbursement list for outpatient care consists of three parts: list A, list B, and list C. All the medicines in the positive list are classified into one of three reimbursement categories (100%, 75%, or 50%) depending on the illnesses for which they have been approved. Pharmaceuticals used for inpatient care are included in the cost of inpatient services and are provided free of charge to patients. Inpatient drugs are purchased by health service providers.